Why the study?
Does direct angioplasty reduce mortality compared to thrombolytic therapy in patients with acute myocardial infarction?
Does direct angioplasty reduce mortality compared to thrombolytic therapy in patients with acute myocardial infarction?
The review suggests starting with thrombolytic therapy for most acute MI patients, followed by selective angioplasty, while favoring direct angioplasty for specific subgroups like those in cardiogenic shock.
Supports selective direct angioplasty in shock or prior CABG; leaves open optimal strategy for most AMI patients.
Both direct angioplasty and thrombolytic therapy can decrease mortality from acute myocardial infarction, but certain subgroups of patients benefit more from one method than the other. Direct angioplasty is favored in patients in cardiogenic shock (with perhaps the exception of those who are elderly or have three-vessel coronary disease) and patients who have undergone previous coronary bypass surgery. Thrombolytic therapy and direct angioplasty seem to be equally effective in patients with acute myocardial infarction who present more than 6 hours after onset of symptoms or have multivessel coronary artery disease. The location of the infarct (anterior versus inferior) does not favor one therapy over the other. We believe that in most patients, the best approach is to begin with thrombolytic therapy and to follow that with selective application of angioplasty when it is clinically appropriate.
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Handlin et al. (1994) studied this question.